Low-Barrier

In sub-Saharan Africa, adolescent girls and young women (AGYW; ages 15-24) face the dual threats of HIV and unintended pregnancy. Challenges to preventing both HIV and unintended pregnancy can be attributed to stigma, lack of perceived risk, provider biases, among others. Despite the availability of new technologies to support self-care (e.g., HIV self-testing (HIVST) kits, pre-exposure prophylaxis (PrEP)), health systems still fail get these critical resources to AGYW in need. The objective of this study is to garner foundational evidence for understanding AGYW’s preferences for how PrEP screening and linkages to dispensation are offered and private pharmacies’ preferences for offering PrEP and identifying pharmacy providers’ willingness to offer such services. Specifically, this study will conduct one discrete choice experiment (DCE) among AGYW to identify commonly preferred program design features (Aim 1) and another DCE among pharmacy shopkeepers to determine the “willingness-to-sell” threshold and understand relative value of adding facets of PrEP services to existing SRH offering (Aim 2). The study will leverage the ongoing study infrastructure for recruiting AGYW and shopkeeper respondents at enrolled study sites in two high HIV-burden regions in Tanzania and administer two distinct discrete choice experiment (DCE) survey, which is a quantitative technique to elicit both stated and implicit preferences and is often used in health policy and planning to shape program designs and identify the most preferred and potentially impactful elements. Access to PrEP in a low-resource setting where young women simultaneously face the threats of HIV and unintended pregnancy is critical to containing the growing number of HIV infections. Understanding the preference of those in need of PrEP and the preference of providers who are will-positioned to supply PrEP can significantly reduce access barriers and improve the health of the population. This proposal embodies a key opportunity to work alongside government leaders in Tanzania to improve upon an already promising intervention (the Queen Club) to meaningfully improve access and uptake of vital prevention services.